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. 2023 Dec 21:15:1093-1105.
doi: 10.2147/NSS.S432829. eCollection 2023.

Impact of Preoperative Sleep Disturbances on Postoperative Delirium in Patients with Intracranial Tumors: A Prospective, Observational, Cohort Study

Yang Liu  1 , Xiaoyu Zhang  1 , Mengyang Jiang  1 , Yiqiang Zhang  1 , Chenhui Wang  1 , Yongxing Sun  1 , Zhonghua Shi  2 , Baoguo Wang  1
Affiliations

Impact of Preoperative Sleep Disturbances on Postoperative Delirium in Patients with Intracranial Tumors: A Prospective, Observational, Cohort Study

Yang Liu et al. Nat Sci Sleep. .

Abstract

Background: Postoperative delirium (POD) is prevalent in craniotomy patients and is associated with high mortality. Sleep disturbances are receiving increasing attention from clinicians as associated risk factors for postoperative complications. This study aimed to determine the impact of preoperative sleep disturbances on POD in craniotomy patients.

Methods: We recruited 130 patients undergoing elective craniotomy for intracranial tumors between May 1st and December 30th, 2022. Preoperative subjective sleep disturbances were assessed using the Pittsburgh Sleep Quality Index on the day of admission. We also measured objective perioperative sleep patterns using a dedicated sleep monitoring device 3 days before and 3 days after the surgery. POD was assessed twice daily using the Confusion Assessment Model for the Intensive Care Unit within the first week after craniotomy.

Results: Preoperative sleep disturbances were diagnosed in 49% of the study patients, and POD was diagnosed in 22% of all the study patients. Sleep disturbances were an independent risk factor for POD (OR: 2.709, 95% CI: 1.020-7.192, P = 0.045). Other risk factors for POD were age (OR: 3.038, 95% CI: 1.195-7.719, P = 0.020) and the duration of urinary catheterization (OR: 1.246, 95% CI: 1.025-1.513, P = 0.027). Perioperative sleep patterns (including sleep latency, deep sleep duration, frequency of awakenings, apnea-hypopnea index, and sleep efficiency) were significantly associated with POD.

Conclusion: This study demonstrated that preoperative sleep disturbances predispose patients undergoing craniotomy to POD, also inferred a correlation between perioperative sleep patterns and POD. The targeted screening and intervention specifically for sleep disturbances during the perioperative period are immensely required.

Keywords: Pittsburgh Sleep Quality Index; confusion assessment model for the intensive care unit; craniotomy; postoperative delirium; preoperative sleep disturbances; sleep pattern.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Working principle of sleep device.
Figure 2
Figure 2
Flow chart of included population.
Figure 3
Figure 3
Different parameters of perioperative sleep patterns in patients with and without POD ((A): Sleep latency; (B) Deep sleep duration; (C) Frequency of awakenings; (D) Apnea-hypopnea index; (E) Sleep efficiency).
See this image and copyright information in PMC

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